European Public School Report 2023: Preliminary results on student population, educational trajectories, mathematics achievement, and stakeholder perceptions

• Luxembourg is a highly diverse country in terms of the socioeconomic, sociocultural, and linguistic composition of its population. This diversity is reflected in the national education system with an increasing share of students speaking a language other than Luxembourgish and/or German at home. In order to deal more adequately with the increasing language diversity of the student population and to counter educational inequalities that presumably result (at least in part) from a curriculum that places high language expectations on a growing number of students, the Luxembourgish government has broadened the educational offer by introducing European public schools (EPS). These schools follow the European curriculum and allow students to select one main language of instruction among the offered language sections (i.e., German, French, and English). • By combining data from different sources (e.g., administrative student data, expert interviews with stakeholders, achievement scores in mathematics from the Luxembourg School Monitoring Programme “Épreuves Standardisées” - ÉpStan), the present report offers preliminary results on EPS in Luxembourg. They consist of (1) the societal demand for EPS; (2) the composition of the student population in EPS; (3) the perception of EPS by school management teams and parents, and tangible education outcomes in the form of (4) educational trajectories; and (5) academic achievement in mathematics among EPS students compared to their peers in schools following the Luxembourgish curriculum. Described below are the key preliminary findings for each of these aspects: (1) Since 2016, a total of six EPS have opened in different locations across Luxembourg and the amount of students attending EPS has increased considerably at both primary and secondary school level. With the number of applicants surpassing the number of places currently available in EPS, it can be concluded that there appears to be high demand for EPS. (2) With students having a low socioeconomic status (SES) and/or students speaking Portuguese at home taking up the offer of EPS less frequently than high SES students and/or students speaking French or English at home, the student population in EPS differs from the student population in schools following the Luxembourgish curriculum (e.g., nationality, language primarily spoken at home, SES). (3) School management teams and parents report a rather positive perception of EPS, with the extended linguistic offer (i.e., possibility to select a language section) being the main reason why parents select EPS for their child. (4) Looking at the educational trajectories of EPS students, preliminary results offer a tentative indication of EPS students showing less school delay than their peers in school following the Luxembourgish curriculum and high continuity in their educational trajectories (i.e., the vast majority of students remains in EPS instead of changing curriculum). (5) With regard to achievement in mathematics at primary school level, the present report indicates that students in EPS perform better than their peers in schools following the Luxembourgish curriculum. At secondary school level, EPS students perform better than their peers in Enseignement secondaire général - voie d'orientation (ESG) and in Enseignement secondaire général - voie de préparation (ESG-VP), while staying below the performance of Enseignement secondaire classique (ESC) students. Although low SES students or Portuguese speaking students in EPS show better achievement scores than their respective peers in schools following the Luxembourgish curriculum it is not yet possible to draw strong conclusions based on these preliminary findings as these student groups currently take up the EPS offer less frequently than their peers considered as advantaged in the context of schooling. Their number is currently too small to allow more robust and in-depth statistical analyses. • The present report’s findings, especially regarding the tangible educational student outcomes, however, must be considered as tentative due to important methodological limitations. Indeed, the small numbers of students in EPS, particularly so for student groups with specific background characteristics (e.g., low SES students, Portuguese speaking students), do not allow separate analyses based on language section, for example. Thus any identified pattern could be sensitive to the inclusion or exclusion of outliers (e.g., students with particularly high or low ÉpStan scores). In addition, the comprehensive EPS school system at secondary school level (i.e., common track) is compared to the ability-based tracked school system of schools following the Luxembourgish curriculum, which limits the interpretability of secondary school data. Regarding the academic achievement tasks in mathematics, it should be noted that they were developed using education standards of the Luxembourgish curriculum. It is thus possible that achievement was underestimated for EPS students (e.g., assessment of mathematical concepts that have not yet been introduced in EPS). To this date, the ÉpStan administered in EPS only assessed academic achievement in mathematics for which a bigger overlap between curricula is assumed than for language subjects (e.g., German, French). Current psychometric shortcomings (e.g., different timepoints of language introduction within the language section in EPS, task development, comparability of tasks) do not yet allow to assess academic achievement in language subjects. • Considering that the ÉpStan do not currently include a measure that operationalises the learning environment, the present report is unable to draw any conclusions regarding which EPS aspect contributes decisively in explaining the observed differences in educational outcomes. Nevertheless, three potential explanations are presented for further exploration: better linguistic fit in EPS (i.e., students learning to read and write in their native or a related language), structural differences between school offers (e.g., primary and secondary education within one institution, the institutionalized quality assurance and flexibility in teacher recruitment in EPS), and the differences in the composition of the student population (i.e., lower uptake rate of the EPS offer by low SES students and Portuguese speaking students). • The finding that low SES students and Portuguese speaking students take up the EPS offer less frequently than their high SES peers and French or English speaking students, and that the EPS student population differs from the student population in schools following the Luxembourgish curriculum, could potentially result out of three main hurdles: namely (1) the application of selection criteria considering that the demand for EPS is surpassing the number of available places (i.e., the linguistic and/or academic profile of applying students is taken into consideration); (2) lacking system knowledge regarding the characteristics of Luxembourg’s education system among all actors involved in education (which makes it difficult to take informed decisions on a student’s education); and (3) potential organizational challenges that hamper the uptake of the EPS offer (e.g., geographical location of the EPS). • In light of the tentative result that students in EPS show better educational outcomes than many of their peers in schools following the Luxembourgish curriculum, two main implications for educational policy can be deduced. First, the student composition of EPS could be diversified in a targeted manner. This could be achieved, for example, by a) encouraging EPS to target student groups considered as disadvantaged in the context of schooling (e.g., low SES students) more effectively, and by b) fostering an encompassing system knowledge (e.g., characteristics, similarities and differences of the two school offers) among all actors involved in education (e.g., teachers, parents, educational advisors, school psychologists) to allow parents to take an informed decision on their child’s education. A second implication would be to introduce certain characteristics of EPS in schools following the Luxembourgish curriculum (e.g., extending the linguistic offer as in the French literacy acquisition pilot project currently implemented in four C2.1 classes). • By progressively integrating EPS into the well-established Luxembourg School Monitoring Programme, the ÉpStan will allow for a more in-depth analysis of potential educational outcome differences between EPS and schools following the Luxembourgish in the future. With the aim of providing reliable data for evidence-based policy making in the field of education, the results from the ÉpStan could in turn be used for the creation of school offers in which all students can make use of their full academic potential irrespective of their individual background characteristics (e.g., SES, language background)

Sexual and reproductive health and access : Results of a rapid epidemiological assessment among migrant peoples in transit through Darién, Panamá

Background: The foot transit of migrant peoples originating from the Caribbean, South America, Asia, and Sub-Saharan Africa through the Darién Forest (DF) in Eastern Panamá towards North America has increased in recent years from approximately 30,000 people/year to >133,000 in 2021. In the DF, there is no food/housing provision nor healthcare access. Very little is known of sexual and reproductive health (SRH) among this population. This study used rapid epidemiological methods to describe the SRH situation among migrant peoples in transit through the DF. Methods: This cross-sectional study randomly selected migrant people in transit (men and women) at a Migrant Reception Station in Darién, Panamá, between January 4-11, 2022. Data collection included a self-applied questionnaire (≥18 years); clinical screening (≥12 years); and HCG, treponemal antibodies, and HIV(I/II) lateral-flow tests with blood samples (≥12 years). Descriptive analyses were used to report findings. Results: In all, 69 men and 55 women participated in the self-applied questionnaire, 70 men and 51 women in clinical screening; 78 men and 63 women in HCG, treponemal antibody and HIV testing. Overall, 26.1% (18/69) men and 36.4% (20/55) women reported sexual intercourse within the past month. The last sex partner was casual among 43.0% (21/49) of men and 27.8% (10/36) of women; of those, 42.9% (9/21) of men and 80.0% (8/10) of women reported this sex was condomless. Among women, 20.0% (11/55) tested positive for pregnancy; 5 of these pregnancies were planned. Of those screened, a reproductive tract infection symptom was reported by 5.7% (4/70) of men and 58.8% (30/51) of women. A total of 32.7% (18/55) of men and 18.2% (8/44) of women reported no prior HIV testing. Of 78 men, HIV and treponemal antibodies were found among 1.3% (n = 1) and 2.6% (n = 2), and among 63 women, 3.2% (n = 2) and 3.2% (n = 2), respectively. Conclusions: This rapid epidemiological assessment found high recent sexual activity, low condom use with casual partners, and a need for increased HIV and syphilis testing and treatment. There is a need for increased testing, condom provision, and SRH healthcare access at migrant reception stations that receive migrant peoples in transit through Panamá

How Can Health Systems Better Prepare for the Next Pandemic? Lessons Learned From the Management of COVID-19 in Quebec (Canada)

The magnitude of the COVID-19 pandemic challenged societies around our globalized world. To contain the spread of the virus, unprecedented and drastic measures and policies were put in place by governments to manage an exceptional health care situation while maintaining other essential services. The responses of many governments showed a lack of preparedness to face this systemic and global health crisis. Drawing on field observations and available data on the first wave of the pandemic (mid-March to mid-May 2020) in Quebec (Canada), this article reviewed and discussed the successes and failures that characterized the management of COVID-19 in this province. Using the framework of Palagyi et al. on system preparedness toward emerging infectious diseases, we described and analyzed in a chronologically and narratively way: (1) how surveillance was structured; (2) how workforce issues were managed; (3) what infrastructures and medical supplies were made available; (4) what communication mechanisms were put in place; (5) what form of governance emerged; and (6) whether trust was established and maintained throughout the crisis. Our findings and observations stress that resilience and ability to adequately respond to a systemic and global crisis depend upon preexisting system-level characteristics and capacities at both the provincial and federal governance levels. By providing recommendations for policy and practice from a learning health system perspective, this paper contributes to the groundwork required for interdisciplinary research and genuine policy discussions to help health systems better prepare for future pandemics

Randomized phase I trial of antigen-specific tolerizing immunotherapy with peptide/calcitriol liposomes in ACPA+ rheumatoid arthritis

BACKGROUND. Antigen-specific regulation of autoimmune disease is a major goal. In seropositive rheumatoid arthritis (RA), T cell help to autoreactive B cells matures the citrullinated (Cit) antigen-specific immune response, generating RA-specific V domain glycosylated anti-Cit protein antibodies (ACPA VDG) before arthritis onset. Low or escalating antigen administration under “sub-immunogenic” conditions favors tolerance. We explored safety, pharmacokinetics, and immunological and clinical effects of s.c. DEN-181, comprising liposomes encapsulating self-peptide collagen II259-273 (CII) and NF-κB inhibitor 1,25-dihydroxycholecalciferol. METHODS. A double-blind, placebo-controlled, exploratory, single-ascending-dose, phase I trial assessed the impact of low, medium, and high DEN-181 doses on peripheral blood CII-specific and bystander Cit64vimentin59-71–specific (Cit-Vim–specific) autoreactive T cell responses, cytokines, and ACPA in 17 HLA-DRB1*04:01+ or *01:01+ ACPA+ RA patients on methotrexate. RESULTS. DEN-181 was well tolerated. Relative to placebo and normalized to baseline values, Cit-Vim–specific T cells decreased in patients administered medium and high doses of DEN-181. Relative to placebo, percentage of CII-specific programmed cell death 1+ T cells increased within 28 days of DEN-181. Exploratory analysis in DEN-181–treated patients suggested improved RA disease activity was associated with expansion of CII-specific and Cit-Vim–specific T cells; reduction in ACPA VDG, memory B cells, and inflammatory myeloid populations; and enrichment in CCR7+ and naive T cells. Single-cell sequencing identified T cell transcripts associated with tolerogenic TCR signaling and exhaustion after low or medium doses of DEN-181. CONCLUSION. The safety and immunomodulatory activity of low/medium DEN-181 doses provide rationale to further assess antigen-specific immunomodulatory therapy in ACPA+ RA

Implementing baseline ecological and human health field assessments in the Revitalizing Informal Settlements and their Environments (RISE) programme in Makassar, Indonesia: an interdisciplinary study

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Background The Revitalizing Informal Settlements and their Environments (RISE) programme aims to assess the health, wellbeing, and ecological impacts of a water-sensitive-cities approach to improving urban informal settlements. Incorporating water-cycle management and green technology sanitation strategies, we aim to reduce flood risk and improve sanitation and waste water treatment leading to cleaner and healthier environments. Here we present the initial design pre-intervention for evaluation in the first 12 settlements in Makassar, Indonesia. Methods Initial environmental, and wellbeing and human health assessments were implemented starting in October, 2018, in 12 settlements in Makassar, Indonesia. Ecological assessments include measuring of temperature and humidity via iButtons installed in select homes, recording of bio-acoustic to measure biodiversity within settlement boundaries, and trapping disease vectors quarterly. Implemented evaluation of environmental contamination includes sampling water and soil sources for total coliforms as well as collecting soil via bootsocks by walking predefined transects. Human assessment includes an annual baseline survey of all settlement households, assessing self-reported symptoms, health-care system utilisation, and subjective wellbeing. Additionally, children younger than 5 years are surveyed quarterly for caregiver reported symptoms of diarrhoea and febrile illness, blood samples and anthropometry are being collected annually, and faeces samples are requested quarterly. Findings Ecological assessments have provided more than a million temperature data points. 21 000 mosquitos have been captured and identified. A total of 114 water samples, 84 bootsocks, and 91 soil samples have been collected, with sampling prior to and during the wet season. We have identified over 600 households within the 12 settlements. Health assessments of children under the age of 5 years have revealed 282 children with collection of 234 faeces samples and 188 blood samples. Interpretation We have successfully implemented baseline ecological and human health and wellbeing assessment tools in all 12 settlements, which will allow for the evaluation of water-sensitive-cities approach in RISE programme.https://doi.org/10.1016/S2542-5196(19)30151-23Suppl

Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster randomised controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Introduction Increasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries. Methods and analysis RISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.pubpu